The District Consumer Disputes Redressal Commission-2 in Chandigarh has delivered a significant verdict against Aditya Birla Health Insurance, ordering the company to pay ₹69,228 to policyholder Sanjeev Rana. Rana had filed a complaint after his health insurance claim was unfairly denied, resulting in medical expenses of ₹54,228, as well as compensation for mental harassment and litigations costs.
Rana was hospitalized at Max Super Specialty Hospital in Mohali in April 2024 due to severe dehydration and elevated creatinine levels. Despite providing necessary documentation to Aditya Birla Health Insurance, the company rejected the claim, arguing that his hospitalization was unnecessary and that his condition could have been managed in an outpatient setting. However, the consumer court disagreed, ruling that the insurer’s decision was arbitrary and without merit.
The court’s investigation found that the hospitalization was necessary and that the insurance provider’s promptness in collecting premiums was inconsistent with their reluctance in settling claims. The court ordered Aditya Birla Health Insurance to reimburse Rana’s medical expenses and pay him an additional ₹15,000 for causing mental distress and covering legal expenses.
The verdict highlights the importance of insurances’ responsibilities towards their policyholders and the consequences of disregarding them. The court’s ruling reinforces the idea that the treating physician is best qualified to determine the necessity of hospital admission. The decision serves as a warning to insurance companies to refrain from denying claims unfairly and to prioritize settling claims in a timely and judicious manner.